Gan Kim Yong
Singapore
“Consumer complaints relating to the secondary resale market for tickets to major events and concerts have generally remained low. Nonetheless, to protect the public from scams on secondary ticket resale platforms, the Police have imposed Code of Practice requirements under the Online Criminal Harms Act to require designated online service…”
“Singapore does not condone the use of forced labour. We criminalise forced labour in Singapore under various laws. Relevant Government Ministries and agencies, such as the Ministry of Manpower, Ministry of Home Affairs and Singapore Police Force, play their part in investigating complaints of suspected breaches in domestic laws that relat…”
“The Association of Banks in Singapore (ABS) discontinued the PayNow nickname feature as scammers had been exploiting the use of nicknames to impersonate legitimate entities and trusted individuals.”
“As of end-2025, around 6,900 private residential buildings have registered their solar installations with SP Group for the export of excess solar-generated electricity to the grid. The installed solar capacity of these residential buildings is 115.3 megawatt-peak (MWp), or around 5.5% of all current installed solar capacity in Singapore.”
“The one-year pilot extension of liquor trading hours has seen strong interest from businesses. As of 31 May 2026, the Police have approved 88 applications for the extension of liquor trading hours from public entertainment outlets in these areas.”
“The Government does not make projections of domestic or regional demand for renewable diesel or sustainable aviation fuel. Demand depends on commercial considerations, evolving market conditions and regulatory developments across different jurisdictions.”
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Every one of 3,841 lines we hold for Gan Kim Yong, in date order, each linked to its source. Free to read, in full, without an account. Page 53 of 77.
“MOH is currently undertaking a holistic review to enhance affordability in the intermediate and long-term care (ILTC) sector through enhancing both Government subsidy and insurance in the form of ElderShield. Today, ElderShield provides cash payouts of $400 a month for up to six years to help defray the cost of care for a severely disabled senior. MOH is reviewing the key design parameters of ElderShield to provide greater protection and support for Singaporeans. We are mindful that enhancements to ElderShield benefits will affect the premiums for policyholders and we have to carefully study the benefits of these enhancements and what they will mean for premium levels. In the meantime, to improve the affordability of ILTC services for Singaporeans, MOH has enhanced the ILTC subsidy framework to provide more help from the Government. Subsidies were increased in July 2012 and the qualifying income raised so that more middle income households can benefit from the subsidies. We also started absorbing Goods and Service Tax (GST) for all subsidised patients receiving care at GST-registered ILTC institutions. In addition, we introduced the Foreign Domestic Worker (FDW) Grant to support middle income households that need a domestic helper to care for their frail or disabled elderly family member, and raised the monthly cash payouts for disabled elderly under the Interim Disability Assistance Programme for the Elderly (IDAPE). These efforts work together to reduce the overall out-of-pocket cost of ILTC services for many Singaporeans. Page: 168”
“MediShield and some Medisave-approved Integrated Shield Plans (IPs) impose lifetime limits on the payable claims for each policyholder. The lifetime claim limit for MediShield is $300,000 and varies across IPs4. Since 2000, 1455 MediShield policyholders have reached the lifetime claim limits and are, hence, no longer insured under the scheme. Since the inception of Medisave-approved Integrated Shield Plans (IPs) in 2005, no IP policyholders have reached their respective lifetime claim limits. The MediShield lifetime limit was increased in 2005 and, more recently, in March 2013 from $200,000 to $300,000. The enhancement was made to provide protection for higher lifetime claims, due to increases in life expectancy and accumulation of claims over time. The Ministry will continue to monitor the trend in policyholders' cumulative claims, in relation to the adequacy of the new lifetime limit. Financial assistance is also available for those who face difficulty with their medical bills at our public healthcare institutions. As part of the ongoing review on MediShield Life to provide greater assurance for Singaporeans for life, the MediShield Life Review Committee is studying the parameters for MediShield Life, including reviewing the lifetime limit. The Committee is expected to present its recommendations for the Ministry's consideration in mid-2014. Page: 167”
“The number of requests for termination of pregnancy in Singapore is appended in the table below. The table below refers to the number of women who underwent pre-abortion counselling. Page: 165 The table below provides the number of kept pregnancy after pre-abortion counselling. Currently, mandatory pre-abortion counselling is conducted by a trained counsellor, that is, a doctor or nurse, in institutions approved to carry out Termination of Pregnancy (TOP) under the TOP Act and Regulations which include both approved public/private healthcare institutions. For unmarried pregnant women below 16 years old, pre-abortion counselling is provided by the Health Promotion Board Student Centre. Page: 166”
“Today, the majority of women seeking abortion already receive counselling. MOH has reviewed the criteria related to pre-abortion counselling and is proposing to extend mandatory pre-abortion Page: 164 counselling to all pregnant women seeking termination of pregnancy in Singapore. We will be consulting the public on this proposal in the second half of 2014. The review of the contents of the pre-abortion counselling is ongoing and it includes the improvement of information provided during counselling to women seeking abortion, as well as strengthening of the training provided to abortion counsellors. More details will be shared in the second half of 2014.”
“About 520,000 Singaporeans have signed up for the Community Health Assist Scheme (CHAS) as at 31 December 2013. Based on our records, we have successfully registered close to 20,500 households living in HDB rental flats for CHAS. This translates to about 40% of all households living in HDB rental flats. The remaining 60% who are not on CHAS includes Singaporeans on the Public Assistance (PA) scheme who enjoy free medical services at public healthcare institutions, as well as younger families who can now qualify for CHAS following the removal of the age floor on 1 January 2014. Working closely with the Agency for Integrated Care (AIC), HPB and grassroots organisations, MOH will continue to explore ways to target our outreach to the lower- and middle-income Singaporean households to encourage more eligible Singaporeans to sign up for the scheme. In particular, for residents of HDB rental flats, AIC has been conducting door-to-door visits, together with grassroots leaders, to assist them in their applications if required.”
“They highlight that relationships require commitment, and it is possible to remain faithful to one’s partner, regardless of one's sexual orientation. This drives home a key STI and HIV prevention message to "Be faithful" to one's partner, rather than to have multiple partners. This helps to protect individuals from STIs and HIV, minimise transmission risks, and, thereby, safeguarding public health. The HPB continually reviews its resources to keep them relevant, appropriate and effective in reaching out to target populations to help them make healthier choices. MOH and HPB receive much valuable feedback from members of the public, expressing a diversity of views. HPB will take into consideration all relevant inputs in our reviews.”
“The Government's policy is that the family is the basic building block of our society. This means encouraging heterosexual married couples to have healthy relationships and to build stable nuclear and extended family units. There has been no shift in the Government's position on this. HPB takes reference from this consistent position in its health promotion activities. The Health Promotion Board (HPB)'s mission is to promote healthy living for all Singaporeans. HPB thus conducts outreach and educational programmes to raise awareness among the public, including youths, on sexual health matters, such as the prevention of sexually transmitted infections (STIs), Page: 151 including HIV and AIDS. HPB tailors its sexual health education initiatives to the health concerns of specific target groups. HPB has identified Young Men Who have Sex with Men (YMSM) as one target group for STI and HIV education. To reach out to this group, HPB works with NGOs, VWOs and professional counsellors to produce educational resources. The Frequently Asked Questions (FAQs) on sexuality and sexual health provide a one-stop resource of factual information from a public health perspective on sexuality, STI and HIV prevention. The FAQs were published on the HPB website in November 2013. The FAQs do not encourage same-sex relationships, but rather provide advice to young persons and their parents on mental and physical health issues from a public health perspective. The FAQs also provide specific information to young people at risk of engaging in sexual behaviours which expose them to STI and HIV. The statement that "A same-sex relationship is not too different from a heterosexual relationship" and the statement that follows "Both require the commitment of two people" should be taken together.”
“There are over 60 nursing homes in Singapore providing some 9,800 beds today for the elderly with high care needs. The mean waiting time for a subsidised nursing home bed is about four months. Seniors awaiting nursing home placement are prioritised according to their care needs, and those with urgent needs will be allocated a nursing home bed earlier. We are proactively ramping up our nursing home capacity to address the needs of Singapore's ageing population and aim to reach 15,600 nursing home beds by 2020. In 2013, MOH added almost 1,000 nursing home beds to the system. Another 3,500 nursing home beds will come on-stream by 2016 through the development of new nursing homes as well as the on-site expansion of existing nursing homes.”
“Cancer patients seeking specialist outpatient care are seen by the Medical Oncology, Radiotherapy and Surgical Oncology specialties. The median waiting times for a new outpatient appointment for these services was eight days or less at the public institutions, including NCC, over the period of September to November 2013. Please see table below. Page: 154”
“The Human Organ Transplant Act (HOTA) allows Singapore Citizens and Permanent Residents (PR) to donate their kidneys, livers, hearts and corneas in the event of death, for the purpose of transplantation to save lives. In the situation where there are no suitable Singaporean or PR recipients, the organ will be offered to a foreign patient before the donated organs deteriorate. From 2004 to 2013, six foreign patients received HOTA corneas as there were no other suitable local recipients. The key objective of Singapore's National Blood Programme is to ensure that all patients in Singapore, regardless of nationality and residential status, have access to a safe and sufficient blood supply when they need it. Blood Page: 153 transfusions are given and prioritised based on clinical indications. The physician in charge decides whether a patient needs a blood transfusion and how much blood is required. The Health Sciences Authority and the Singapore Red Cross work in partnership to collect blood from altruistic donors on a voluntary, non-remunerated basis. Donors include Singaporeans, PRs and non-residents. This approach of altruistic donation and inclusive recruitment ensures that the transfusion needs of all patients in Singapore are adequately and safely met.”
“MOH regularly reviews the healthcare financing framework to ensure the affordability of healthcare services. In July 2012, MOH increased the funding rates for MOH-funded nursing homes. We also raised the qualifying per capita household income to extend Immediate and Long Term Care (ILTC) subsidies to more middle-income households and absorbed GST for all subsidised ILTC patients receiving care at GST-registered ILTC institutions. From 1 July 2013, we also expanded the Community Silver Trust (CST) to cover long-term care providers' operating expenses. CST is a dollar-for-dollar donation matching grant provided by the Government to MOH-funded Voluntary Welfare Organisations (VWOs) in the ILTC sector. This additional source of funds helps VWO nursing homes defray operating costs to further improve the affordability of nursing home care. MOH will continue to review funding rates to ensure that ILTC services, including nursing home care, remain cost-effective and affordable.”
“In addition, more than 80 companies have participated in smoking cessation activities since 2011, and among employees who received on-site quit counselling and Nicotine Replacement Therapy (NRT), 30% achieved long-term cessation. The "Let's Quit The 28-Day Countdown" challenge aimed to inspire smokers to make a personal pledge to quit smoking. Over 3,400 smokers enrolled in the challenge which took place between May and July 2013. Preliminary data showed one in 10 participants have persisted in staying smoke-free for 28 days. Quitting smoking is not an easy task. The effectiveness of our smoking cessation programmes ranged between 10% and 40%, which is in line with what is observed internationally1. Hence, it is important to prevent our youth from experimenting and establishing a regular smoking habit in the first place. Smokers who have the support of their family, friends, and employers are more likely to quit smoking successfully. My Ministry will continue to review and strengthen our smoking prevention and control efforts. Page: 131”
“The Tobacco (Control of Advertisements and Sale) Act prohibits the supply, purchase, possession and use of tobacco products among persons aged below 18 years. The number of underage youths caught buying tobacco has decreased from an annual average of 57 in 2010 and 2011 to an annual average of 25 in 2012 and 2013. The number of underage smoking offences has also decreased from an annual average of 6,500 in 2010 and 2011, to an annual average of 5,500 in 2012 and 2013. These decreases were observed notwithstanding the increased enforcement efforts by the Health Sciences Page: 130 Authority. Legislation against underage smoking is one aspect of our multi-pronged, whole-of-society approach to tobacco control that comprises legislation, taxation, health promotion and education, and smoking cessation. Our aim is to de-normalise tobacco use in Singapore. Education and awareness, with appropriate interventions, are critical in preventing smoking initiation among underage youths. Hence, the Health Promotion Board (HPB) has worked closely with MOE to incorporate anti-tobacco messages into the school curricula and co-curricular activities. Helping smokers quit smoking is another important strategy to reduce tobacco consumption. The I Quit Programme reached out to more than 13,200 smokers in 2012 and intervenes broadly at the population level through telephonic services, such as QuitLine, which have been shown to achieve a quit rate of 30%. In 2012, over 200 youth smokers enrolled in HPB's school-based smoking cessation programmes, which achieved an average quit rate of about 40%.”
“Madam, I want to thank Mr Liang for his points. Indeed, we want to find different strategies to develop home nursing. Financing is one. Page: 42 MOH is reviewing the financing structure for home nursing so that the financial support that we give to patients, especially needy patients, should, by and large, be set in neutral so that it does not penalise them for staying at home. Instead, today they get a higher subsidy and lower cost, lower cash upfront, when they are hospitalised. This will not incentivise or encourage them to do home nursing. These are things that we will review over the next few months. We hope to be able to share with the House in time to come our ideas on how we can encourage and develop these home nursing centres.”
“Over the long term, we will find that it is better for our elderly to be supported and cared for by their family because the elderly themselves want to be with their family and want to stay at home. It is an environment that they are more familiar with and more conducive for their health and recovery. So, we should focus a lot more on developing home care and see what kind of support services that we can evolve over the next few years to support more elderly to be cared for at home. We will be building a lot more day-care centres so that these elderly can come down from their flats during the day to be cared for by professionals and to do exercises to stay healthy, maybe even receive therapy. After that, at the end of the day, their family members can then come and pick them up and take them home. These senior day care centres are very important and we will be building them over the next few years. It is important for us to also develop home nursing so that for patients who need nursing care at home, we will have sufficient facilities to support them. These are various initiatives we need to put in place as part of our Healthcare 2020 Master Plan. Each piece is linked to other pieces. We need to look at it in a holistic way.”
“Madam, I can empathise with the Member's concerns reflecting the concerns of many of our elderly. I met many elderly patients in my own constituency and I can understand their concerns. But it is also important for us to look at this issue of caring for the elderly in a more holistic way. First, we want to find opportunities to reach out to them, to engage them, to encourage them to adopt a healthy lifestyle, to help them stay healthy. One important factor in helping the elderly stay healthy is to help them comply with their medication. I think many elderly, as you find out during your house visits, have a lot of medication to take because of multiple conditions. Sometimes, they forget to take the medication and, sometimes, because of side effects, they decide to stop their medication. And as a result, their conditions get worse. So, we would like to encourage them to stay on their medication. That will help manage their conditions and minimise the progression of their conditions and reduce the risks of having to be hospitalised. Page: 41 Some elderly are concerned about the cost of medication, and I would encourage Members to reach out to them and tell them they do not have to worry about the cost. If there is, indeed, a concern about financial affordability, let me know and I will take a look at them on a case-by-case basis. This is the same for home care. If you have a need for financial support, do let us know. But I would hesitate to have a model where the bulk of the elderly are cared for in an institution, whether they are community hospitals, step-down care or a nursing home.”
“The manpower development cannot be accelerated at will because we need time for people to train, and to acquire the necessary skills and experience. I would say this, we would try to build the Sengkang General Hospital as fast as practically possible, but I would not want to accelerate it beyond a point where it actually poses a risk to the project as well as to the patients.”
“Madam, beyond Sengkang, we are looking at four more General Hospitals between 2020 and 2030. This is the current projection. But 2030 is still a very long way off. We will need to continue to monitor very closely and the plan will have to remain very dynamic. And if our demography shifts, our disease pattern shifts, and the healthcare landscape changes, we will have to evolve our care model. As I mentioned just now, we should not rely on building acute hospitals as the only solution. We need to look at the entire system, transform our care model to ensure that we are efficient and it is also a good way to ensure that we are cost-effective. He asked about bringing forward the construction of Sengkang General Hospital. I have been asked this question several times. It is not just about the physical construction. We have broken ground on the Sengkang project. It will take a while for us to complete the project. The current schedule is 2018. Bringing forward the construction has several risks. We want to make sure that the project is well built because it is a very complex project. This morning, I was at the Ng Teng Fong Hospital's topping-out ceremony, and you can see that the hospital is taking shape. But it also reminds all of us it is a very complex and Page: 40 big project. It is not just a physical infrastructure. It is also important, even as we build the infrastructure, to ensure we also develop the manpower capacity. For Ng Teng Fong Hospital, for example, currently we are building the capacity of manpower and they are operating in Alexandra Hospital, undergoing training and trying to build a team together so that when Ng Teng Fong Hospital is ready to open by the end of the year, the team is ready to move across. So, it involves building manpower as well.”
“The key is to ensure that we have a very strong and robust medical protocol to ensure that patients are given the necessary treatment and support. There will always be medical risks and I think, as doctors and hospitals, they accept that. We look forward to working together with some of the private operators and tap on their capacity with a win-win outcome.”
“It is as real as you can get because we do have running collaboration with the private hospitals, as I mentioned, between Changi General Hospital and Parkway East. They have already been running for a year or more. What Changi General Hospital does is that it has an agreement with the Parkway East to make use of the wards. Changi's doctors are there to look after the patients and they manage the patients. They also tap on the support services and the nurses. But the doctors come from Changi General Hospital, making use of the beds, that is one collaboration. We are also discussing collaboration in a deeper way, including the use of emergency department, building up the capability of the private hospitals to make sure that they are able to respond to emergencies. For those patients who are sent to these private hospitals, they would then be treated as if they are in the public hospitals and they would be treated by doctors in the private hospitals. So, these are some of the collaborations that we are discussing. Page: 39 What I mentioned were those that already have been in operation for some time. There are new models that we are looking at and some of these, because there are ongoing discussions with the private operators, he will understand that I will not be able to share with him more details. There is also collaboration between NUH with Westpoint Hospital. Basically, NUH rented a ward from Westpoint and is making use of the supporting services at Westpoint Hospital. So, there are different models and we are exploring different possibilities. As the Member said, private operators may have different concerns and different considerations. But I think as far as medical risks are concerned, as a hospital, there are certain risks.”
“Of course, hospital bed occupancy is also a very dynamic number. It varies from day to day as you can imagine. It also varies from hospital to hospital. It depends to a very large extent Page: 38 on the number of emergency admissions and the number of discharges the hospital is able to undertake on each day. So, it depends on how many patients arrive at the A&E, how many patients we plan to discharge. On certain days, when we plan for a certain number of discharges, there could be a significant number of emergency cases that arrive at the emergency departments and we have to address them and we may have to hospitalise them. If that situation happens, you tend to see a high bed occupancy rate for that particular day of that particular hospital. Once you admit a patient into a hospital ward, it is not just for one day. Sometimes, it takes two or three days. For an elderly, it may take a bit longer. So, even for that particular day, the occupancy rate is high because of high admissions. It will take a few days for the occupancy rate to come down even if you have low admissions because the patients will take up the bed for a couple of days, or three-four days, depending on the situation. So, it is not just a simple factor. That is why I explained in my answer that a combination of factors will contribute towards a high bed occupancy. Assoc Prof Tan Kheng Boon Eugene (Nominated Member): Mdm Speaker, I would like to ask the Minister how real is the collaboration with the private sector. If I were to run a private sector hospital, I am happy to be the landlord but I would not be prepared to take on the manpower demands. I would also not want to take the medico-legal risks. As such, how real is private sector collaboration then?”
“Madam, first, let me explain that for the wards in the hospitals, the conversion has to take into account the infrastructure design. It also needs to take into account the manpower capacity as well. Some of the wards in B1 may not be able to be converted into C class wards by simply adding beds because we need to ensure that the pipes are there, the wiring is there, and the system is capable of accommodating more than the number of beds that are currently in B1. But in the hospitals, what they have done is they have taken a very practical approach for patients when the bed capacity is tight. When they need more hospital beds to cater to the demand of the patients, they would allow the patients to be uplodged. Even if they are C class patients, we allow them to be uplodged to B2 or B1 wards. So, I think all the private wards are being used as a potential capacity to cater to the need of the patient when the bed demand is high. On the second point of foreign patients, I think I have replied in one of the Parliamentary Questions (PQs) earlier. Foreign visitors form a very small component of our hospital beds. Some of them come for day surgeries, some of them are in the emergency and treated as outpatients and they go off. From my recollection, I remember that foreign visitors in our hospitals take up less than 2% of our hospital beds and these are sometimes urgent cases and some of them are already here in the emergency department. From the hospital's point of view, these foreign visitors do not pose a significant stress on our hospital beds. If you look at the historical trends, as I mentioned earlier, I think extension of the length of stay and the rising proportion of patients aged 65 and above are key drivers of hospital bed demand.”
“But that is primarily the approach that the Ministry is taking and we are working very closely with the various hospitals, including the private hospitals, to look at the possibility of tapping on their expertise as well as their capacity.”
“Madam, I am glad that Dr Lam has actually spelt out quite a lot of things that the hospitals are already doing. Many of the suggestions that Dr Lam has put forward were outlined in the Healthcare 2020 Masterplan, including streamlining our processes, ensuring better care in the community and also right siting, as well as building up capacity of the downstream, intermediate and long-term care, so that patients who do not need the care of acute hospitals can receive the necessary treatment in the community, as well as the intermediate and long-term care without having to be hospitalised. Dr Lam also asks whether we can take a holistic approach. I think that is very important. That is why I mentioned in my reply earlier that adding hospital beds alone will not be sufficient. We will need to look at how we can transform our care model, in particular. It is important for us to take a look at our primary care sector because many of the patients who are old and frail tend to suffer from chronic diseases. If we do not manage them well, these chronic diseases will deteriorate very fast and they will end up sending the patients to the hospitals. If we are able to manage them better in the community, we can slow down the progression of these conditions. If they can stay healthy, we can minimise the frequency of hospital visits or hospitalisation. This way, we will not only free the capacity for other more urgent and more acute patients but also allow the patients to recover better in a homely environment, in their own Page: 37 home, in the community, with the support of their loved ones as well. I want to thank Dr Lam for his many suggestions. I am not sure whether I have answered all his questions.”
“These transformation efforts, together with planned increases in bed capacity, will allow us to better manage our healthcare needs in the decade ahead.”
“Over the medium term, the demand for acute care services is likely to continue to rise as our population ages. MOH has already put in place plans to build additional bed capacity across care settings under the Healthcare 2020 Masterplan. In 2014, 1,200 beds, including community hospitals and nursing homes beds, will be added to the healthcare sector, and 10,000 more beds will be added by the end of 2020. Besides the upcoming Ng Teng Fong General Hospital and Jurong Community Hospital which will open in 2014 and 2015 respectively. Yishun Community Hospital will open in 2016, Sengkang General Hospital and Community Hospital will open in 2018, and a new Community Hospital in Outram will open by 2020. In the intermediate and long-term care sector, we are building various eldercare facilities, including 12 new and replacement nursing homes by 2016. Even as we add capacity, we need to also transform the model of care because a hospital-centric system is not the best in meeting the care needs of an ageing population. We need to help our senior population stay healthy and manage their chronic conditions better so that they do not need to be hospitalised frequently. We would also need to provide good support in the community to allow them to recuperate well after a hospitalisation episode. An example of a care transformation programme is Tan Tock Seng Hospital's Virtual Hospital concept. This involves assigning a care manager to monitor frail patients who have a history of multiple admissions to hospital, and help them better manage their conditions, so that they can get better, stay healthy and not have to visit our hospitals often. We also need to build up our primary care and intermediate and long-term care sectors and integrate them better with our acute hospitals.”
“These multidisciplinary teams, comprising doctors, nurses and other healthcare professionals, will continue to support the patients and ensure that the caregivers are able to provide proper care for the patients. This helps to give the patients and their families greater assurance and facilitates timely discharge. Families who need time to make permanent care arrangements at home are able to tap on the Interim Care-giver Scheme at Changi General Hospital, Tan Tock Seng Hospital and several other hospitals and community hospitals. As of December 2013, about 300 patients have benefited from this scheme. In view of the growing healthcare needs, we have added more than 300 beds in our public hospitals over the past six months. This was done by adding more beds into existing wards, re-commissioning beds at the Communicable Disease Centre, and converting office and other non-clinical space into bed space. In addition, close to 1,000 more nursing home beds were added last year, which helped to take over from the hospitals lower acuity patients who need longer term care. Second, we are optimising national capacity by initiating transfers from acute hospitals with a tight bed situation to others with higher bed capacity. We are also tapping on spare capacity in the private sector. For example, public-private partnerships have been forged between Changi General Hospital and Parkway East Hospital; and also between National University Hospital and Westpoint Hospital. We now have almost 50 beds from these private hospitals. Page: 35 We are exploring further collaborations with the private hospitals. We will continue to monitor the situation closely and work with our hospitals on all fronts to ensure that patient safety and care are not compromised.”
“Madam, a combination of factors contributed to the high Bed Occupancy Rate of 87.2% early this year, higher on some days and in some hospitals. With an ageing population, there are now more old and frail patients who need hospitalisation. The proportion of public sector admissions from patients aged 65 years and above has increased from 28.6% in 2006 to 33.4% in 2013. Older patients also tend to stay longer in hospitals because it takes longer for their conditions to stabilise and for them to be eligible for discharge. The Average Length Of Stay (ALOS) for patients aged 65 and above has lengthened from 7.8 days in 2010 to 8.2 in 2013. Page: 34 In comparison, younger patients' ALOS has actually shortened during this period. With shrinking family sizes and weaker family support, over time, family members may not be ready to take the patients home in a timely manner and this will also result in a longer stay in the hospital. We address the capacity issue from both the short-term and the long-term perspectives. In the short term, we are actively managing the capacity in two ways. First, we are managing capacity in each hospital by facilitating timely discharge of patients to appropriate care settings, including community hospitals and nursing homes, as well as the patients' own homes. To better support our patients and their families, our hospitals are going beyond the physical confines of the hospital to provide care. Hospitals, such as Changi General Hospital, Khoo Teck Puat Hospital and Tan Tock Seng Hospital, have formed transitional care teams to support patients in their homes initially after discharge, if necessary.”
“We see this happening around the world and this is why healthcare is a major preoccupation of many governments as they struggle to manage overall spending to keep healthcare cost affordable. And this is why we help Singaporeans put aside savings in Medisave and we try to pre-fund as much as we can in our MediShield, as this will help us avoid overly taxing the next generation. If we allow Medisave to be used freely and spread over the next few years, all these savings that we have taken so many years to accumulate will dissipate quite quickly. And what would we have left when we ourselves grow old? This may impose an undue burden on our next generation. And will this system be sustainable? Will we have greater peace of mind as a result of that? So, we will continue to see how we can help Singaporeans share the burden of their healthcare cost. But, at the same time, it is also very important for us to keep our economy healthy and growing so that we can provide good employment opportunity, as well as rising income, so that Singaporeans can better afford healthcare cost, and we can have more resources as a Government to help those who may need an extra helping hand. Finally, as the Health Minister, I must say this – it is still most crucial for us to help to keep Singaporeans healthy so that we can reduce the burden of healthcare cost, not only on individuals but also on the society as a whole. So, Page: 118 I hope that we can work together to add life to years and not just years to life. [(proc text) Question put, and agreed to. (proc text)] [(proc text) Resolved, "That Parliament do now adjourn." (proc text)] Adjourned accordingly at 6.45 pm to a date to be fixed. Page: 119”
“From August 2013, the Government will also be contributing $3,000 into every newborn Singaporean's MediSave to help them with a healthy start in life. We are making MediSave use more flexible so that Singaporeans can tap on more of their savings while preserving adequate balance for premiums and co-payments in old age. Further help from Medifund is also available for those who still face difficulties despite insurance and subsidies. Medifund is a very targeted support and it covers up to the full bill of a healthcare bill that patients may incur. So, we have to assess each case very carefully to ensure that help really goes to Page: 117 those who, indeed, need such help. And the criterion is quite different from the financial assistance through CHAS and, therefore, CHAS may not be able to be used for assessment for Medifund eligibility. The healthcare financing system in Singapore is fundamentally sound but we need to future-proof it so that it remains effective and relevant for many more years to come. This is our unique approach. Subsidies and the 3Ms will remain a core to our financial framework. But we will continue to look at how we can strengthen this subsidy-plus-3Ms to give Singaporeans greater peace of mind. Through collective responsibility, through Government subsidies, through risk-pooling from insurance and family support, we can help to manage and share the burden. But we must also keep an eye on overall cost which will have to be borne by future generations if we are not careful. And, in fact, if we do not carefully manage healthcare cost, the tax burden on the population will increase significantly as we will have more and more elderly. Our children's generation will be paying for our healthcare cost when we ourselves grow old.”
“Insurance payouts will be funded by premiums paid into the insurance fund. If coverage improves, payouts will go up and premiums will need to rise. And I am happy to note that Mr Giam recognises this, too. But we understand that there are concerns about the affordability of premiums, as Dr Intan and Mr Giam both pointed out. And, therefore, the Government will provide more targeted help for MediShield premiums. First, for our seniors, they have worked very hard to build Singapore to what it is today, but they earn less and have fewer safety nets when they were younger and working. They would need more help and, therefore, the Government is working on a special Pioneer Generation Package to help them pay for MediShield Life premiums so that they need not worry about healthcare in their old age. This will also relieve the burden on their children as well, who may be supporting their elderly parents. Similarly, as Dr Intan and Mr Giam have suggested, the Government will also help the lower-income pay for their MediShield premiums. For younger Singaporeans, we are studying how to help them pay for part of their old-age premiums earlier so that they do not have to pay so much premiums when they are old. This is what we call pre-funding, as Dr Intan suggested yesterday and Mr Giam touched on today. There is already a small component of pre-funding in today's MediShield, but we are studying if we can do more and to what extent we can enhance it. Through MediShield Life, the Government will pay even more for healthcare for the vulnerable but in a more targeted way. The Government also provides annual MediSave top-ups to the elderly through our GST voucher and through Workfare for the low-income.”
“But we will need to calibrate carefully and will continue to review to ensure that co-payment will remain affordable. We must recognise that with an ageing population and the changes in the family structure, we will need to shift more towards collective responsibility and risk-pooling. In addition, as we have announced earlier this year, the Government will take on a greater share of the healthcare cost. Over the last five years, Government spending on healthcare increased at 15% per annum. This is much faster than inflation, GDP growth and, in fact, much faster than the growth in national healthcare expenditure. In recent years, we have increased subsidies significantly – through CHAS and increased subsidy for the intermediate and long-term care sector. As we have announced earlier, we are also looking into enhancing subsidies for the SOCs and we will share more details on this in time to come. We will continue to do more to increase the Government's share from the current one-third to 40% or more, but we will need to be very careful and to be more targeted to help the low-income as well as the elderly. Beyond subsidies, we will help Singaporeans with their share of healthcare cost through greater risk-pooling – MediShield Life, in particular – so that Singaporeans need not face the uncertainties in their health alone. And I am glad that Mr Giam supports MediShield Life. To enhance risk-pooling, we plan to introduce MediShield Life for better coverage for the larger hospitalisation bills, extend coverage to all Singaporeans, and for life. We have appointed a Review Committee to look into this in detail and this is a major step we are undertaking from which there will Page: 116 be no turning back. This is why we have to consider this step very carefully.”
“The key strategy of this was outlined in our Healthy Lifestyle Masterplan announced earlier this year. Mr Giam also talked about co-payment. Co-payment is a very important component of our strategy to moderate healthcare cost. Co-payment, in fact, plays a very important role in our healthcare financing framework in preventing over-consumption. As Mr Giam pointed out, co-payment encourages our healthcare providers to focus on the more cost-effective options of treatment. So, decisions are also made by service providers as well and not just patients. As Mr Giam has pointed out earlier on, the providers also need to be guided, they also need to be incentivised, to provide the right, appropriate treatment for the patients so that they are more cost-effective. Therefore, we need to be mindful in managing both the patients as well as the providers. And we have calibrated the amount of co-payment very carefully to ensure that they will Page: 115 remain affordable. But there is room for us to provide more help. We have announced earlier that we do intend to see how we can reduce the patient's share of healthcare cost, including co-payment, through Government subsidies, as well as risk-pooling through MediShield Life. We are also looking at injecting more flexibility in the use of Medisave. This includes a review of MediShield co-payment for the very large bills, which Mr Giam talked about, as well as looking into the subsidy structure at our specialist outpatient clinics. These reviews are currently underway. For the lower income, we will also provide Workfare to help them with healthcare cost. Workfare will contribute to their CPF Medisave accounts. Co-payment will continue to be an important part of our financial framework to moderate the cost of healthcare.”
“Mdm Speaker, thank you for allowing me to speak on this Motion. Madam, healthcare cost was a key focus in our Healthcare 2020 announced in 2012. It was also a key theme in this year's National Day Rally. MOH takes a multi-pronged approach to help Singaporeans with their healthcare cost. First, at the national level, we must keep healthcare cost low for all Singaporeans. We spend 4% of our GDP on national health expenditure. This is less than many other countries, but with good outcomes. Life expectancy rose from 78 years in 2001 to about 82 years in 2010. We have also seen steady improvement in other indicators, for example, lower premature mortality, death rate for heart disease, aged 35 to 64, fell from 76.2 per 100,000 in 2001 to about 50 in 2010. This is comparable to the top 25% of OECD countries, roughly on par with the United Kingdom and Sweden. We should bear in mind that we are still a young nation in terms of our population, compared to many of the developed countries, although ageing is picking up pace. Expenditure will, indeed, increase with an ageing population. Therefore, it is important for us to manage overall healthcare cost. And we do this through three key thrusts. Firstly, even as we expand capacity to meet healthcare demand, we must also work on right-siting the patients to avoid over consumption which will drive up cost. Secondly, we must continue to improve productivity and encourage innovation in healthcare delivery. We must continue to seek new models of care that are more cost-effective. Thirdly, we must also preserve the focus on personal responsibility and step up our efforts to promote healthy lifestyle and strengthen our support for preventive healthcare.”
“These methods include using cold turkey withdrawal, undergoing smoking cessation counselling, and receiving approved pharmacotherapy interventions such as nicotine replacement therapy and other non-nicotine medications that are available. We will continue to closely monitor the developments and studies regarding emerging tobacco products, such as e-cigarettes, and seek new ways to strengthen the effectiveness of our tobacco control measures in line with international guidelines and practices. Page: 192”
“Electronic cigarettes (e-cigarettes) have been marketed as safer, healthier alternatives to tobacco smoking, and as smoking cessation devices. However, their effectiveness in helping smokers quit tobacco Page: 191 use has yet to be demonstrated, similar to the requirements for other Nicotine Replacement Therapies (NRTs). Concerns have also been raised about the safety of e-cigarettes as they contain nicotine. International studies have shown that they can expose users to toxic and cancer-causing substances. A local study conducted by HSA found poor consistency between actual nicotine content in e-cigarettes and the amount labelled. In addition, e-cigarettes could potentially be a "gateway" for the young to become addicted to nicotine and lead to the use of conventional cigarettes and the development of a smoking habit. The World Health Organization (WHO) has concluded that until e-cigarettes are deemed safe, effective, and of acceptable quality by a competent national regulatory authority, consumers should be strongly advised not to use them13. The UK's Medicines and Healthcare Products Regulatory Agency announced plans in June 2013 to regulate e-cigarettes as medicines with effect from 2016, but also notably stated that the quality of e-cigarettes currently in the UK market was such that they cannot be recommended for use14. We share the WHO and UK's concerns over the lack of efficacy and safety of e-cigarettes, and their effects on long-term health. Until there is strong, conclusive evidence supporting the safety and efficacy of e-cigarettes, MOH will continue to adopt a prudent approach and prohibit the import, distribution, and sale of e-cigarettes in Singapore. Smokers who wish to quit smoking should use methods that have been proven safe and effective.”
“MOH regularly reviews catastrophic and long-term care insurance coverage, MediShield and ElderShield respectively, to ensure they meet Singaporeans’ needs. We have undertaken a major review of MediShield. With the introduction of MediShield Life, all Singaporeans will benefit from better coverage for large subsidised hospital bills. ElderShield provides basic protection to help meet the costs of long-term care due to severe old-age disability. Today, the scheme provides monthly cash payouts of up to $400, for up to six years. We are in the process of reviewing the key design parameters of ElderShield, taking into consideration long-term care needs and the impact on ElderShield premiums to support higher benefits.”
“The vast majority of patients in the public hospitals, or more than 95% of them, settle their hospital bills within two months of discharge. As at end-2012, the total arrears due from patients that exceeded two months amounted to about 2.5% of the public hospitals' total operating expenses. These figures include arrears brought forward from prior years. They also include patients who are paying their outstanding bills by instalments, or are awaiting assessment for financial assistance by the hospitals. A significant part of the arrears are eventually recovered or paid up over time, leaving a smaller portion amounting to about 1% of total operating expenses that becomes bad debt and have to be written off eventually. In some instances, this could be due to the patient remaining uncontactable despite repeated attempts, or even due to disputes regarding the treatment. The trend of arrears has remained similar over the last five years and do not suggest increasing unaffordability of healthcare bills. We are committed to keeping healthcare affordable for Singaporeans. Should a patient express Page: 151 difficulty with his or her hospital bill, our hospitals will assess the case and explore options for financial assistance, such as instalment payments or MediFund assistance.”
“The table below shows the breakdown of annual co-payments for subsidised bills faced by MediShield policyholders from 2010 to 2012, based on the MediShield benefit design. The majority had annual cumulative co-payments, including the annual deductible, of less than $6,000. Co-payment refers to the bill amount payable by the policyholder after Government subsidies, MediShield and payouts from third-party payers, such as employer benefits. The co-payment amount can be paid through MediSave and cash. Page: 175”
“Fewer than 0.1% of MediShield policyholders reached the policy year and lifetime limits in 2011 and 2012. The breakdown is shown below. The MediShield policy year and lifetime limits were recently increased in March 2013 from $50,000 to $70,000, and from $200,000 to $300,000 respectively. These enhancements will address concerns that an increasing number of policyholders will exceed the policy year and lifetime claim limits, with ageing and accumulation of claims over time. As these limits were just raised in March 2013, we will monitor the trend in policyholders exceeding these new limits each year. Financial assistance will continue to be available for those who face difficulty with their medical bills at Page: 174 our public healthcare institutions. As part of our study on moving towards MediShield Life to provide greater assurance for Singaporeans, the Ministry will continue to consider further enhancements to the scheme, including the policy year and lifetime limits.”
“As at June 2013, 3.6 million members, or 93% of the resident population, were covered under MediShield. The breakdown of MediShield policyholders by age group is presented below. Page: 172 The maximum coverage age for MediShield was recently raised from 85 to 90 years in March 2013, in view of the increasing life expectancy of Singaporeans. As a next step, with the proposed move to MediShield Life, we will be studying enhancements to provide universal, lifetime coverage for all Singaporeans, including the most elderly. Page: 173”
“Between 2008 and 2012, the amount of claims paid out by MediShield annually doubled, while the amount of premiums collected increased by about 40%. The claims paid out by MediShield are expected to further increase as the population ages and with the expansion of coverage to psychiatric, congenital and neonatal conditions from March 2013. The following table shows the premiums collected, claims paid and required changes to reserves10 to fund future MediShield liabilities for the period from 2008 to 2012. Page: 171 As a not-for-profit and self-sustaining insurance scheme, MediShield premiums are actuarially calculated to cover all expected liabilities for current and future years, which include policyholders' claims and premium rebates to help policyholders with old-age premium affordability. A portion of the premiums collected is also set aside as reserves and capital, in line with the Monetary Authority of Singapore (MAS)'s Risk-Based Capital framework and risk requirements to keep the Fund solvent in case of adverse risks.”
“Last September, the Government announced plans to develop 39 Senior Care Centres (SCCs) by 2016. These centres are integrated day eldercare facilities that provide a range of aged care services, such as day care, dementia day care, day rehabilitation and basic nursing services. In the past year, we have opened three new SCCs9 – one each in the Central, Eastern and Northern regions. Three more SCCs will open within the next six months. These centres are operated mainly by voluntary welfare organisations or social enterprises. The remaining centres are expected to be completed by 2016. The SCCs will be located within the community to be more accessible to seniors, taking into consideration several factors, such as the demographic profile in the area, the supply of and demand for eldercare services in the area, and the availability of suitable sites. We also consider whether the sites are accessible by public transport and have barrier-free access features. We are also working with existing established providers of eldercare day services to expand their centres into full-fledged SCCs to provide a Page: 170 comprehensive range of services under one roof, where space allows. For new centres built by the Government, we will select operators based on a number of criteria, such as their proposed model of care and track record in providing aged care.”
“Nevertheless, there is room to further improve the screening participation rate. MOH will continue to look into how we can encourage more Singaporeans to undergo appropriate screening, and make screening even more convenient and affordable. Page: 146”
“Lower- Page: 145 income Singaporeans receive all these tests for free and only need to pay GP consultation fees. For community-based screening, the cost of blood tests to screen for chronic diseases is $2 to $5. Under the ISP, GPs can refer women for mammography for breast cancer screening at Breast Screen Singapore (BSS) centres at 16 polyclinics at a subsidised cost of $50 for citizens. Women aged 50 and above can use Medisave to pay for mammograms at all Medisave-approved screening centres, including the BSS centres. Patients are charged for screening under the ISP as the health of an individual is a shared responsibility. We have also targeted Government subsidies at those who need help most. To make screening even more affordable and accessible, the Community Health Assist Scheme (CHAS) has been enhanced to increase the coverage of subsidies for screening tests under the ISP. From 1 January 2014, the recommended tests will be fully subsidised by the Government for CHAS patients at accredited GP clinics. They will also enjoy subsidies for GP consultation charges of up to $18.50 per visit, for their screening and subsequent follow-up consultations, up to two times a year. The results have been encouraging. In the National Health Survey 2010, among Singaporeans aged 40 to 69, 71% had been screened for high blood pressure in the past year; and 61% and 64% had been screened for high blood cholesterol and diabetes respectively in the past three years, in accordance with the recommended frequency of screening. In terms of cancer screening, 48% of women aged 25 to 69 had undergone the Pap smear test within the past three years; and 10.3% of Singapore residents aged 50 to 69 had a Faecal Occult Blood Test (FOBT) within the past one year.”
“The nationwide Integrated Screening Programme (ISP) offers affordable and convenient screening for high blood pressure, high blood cholesterol and diabetes, as well as breast, cervical and colorectal cancers to Singapore residents for the recommended age-groups. Under the ISP, Singapore residents who reach 40 years of age receive invitation letters to go for the various ISP screening tests at GP clinics. Those who are screened receive rescreen invitations according to the recommended intervals in subsequent years for the various screening tests. To enhance accessibility, HPB collaborates with partners, such as People's Association, as well as companies, to bring subsidised health screening to residents in the community and workplaces. The total number of residents aged 40 years and older who received first invitation letters and rescreen invitations were 490,000 in 2011 and 200,000 in 2012. In 2011, 36,000 people attended health screening under the ISP and 19,000 people in 2012. The total number of invitations and residents who attended health screening was higher in 2011 because 365,000 invitation letters were sent to women aged 50 and above who were due for their mammogram screening in conjunction with the launch of the Celebrate Wellness (CW) programme, a HPB partnership initiative with WINGS and Toteboard. Costs for screening services under the ISP have been kept affordable. For example, the cost of the blood tests in the GP clinics to screen for diabetes and high blood cholesterol is $8, the cost of Pap smear to screen for cervical cancer is $15, and the cost of the Faecal Immunochemical Test (FIT) which screens for colorectal cancer is $30. This is in addition to the GP consultation fees.”
“Currently, MOH, through the Agency for Integrated Care (AIC), has been actively promoting CHAS to residents in HDB rental flats by conducting door-to-door visits together with the grassroots leaders to encourage sign-ups for CHAS. Through these visits, those who live in HDB rental flats can be assisted in their applications for CHAS and the benefits of the scheme can also be explained to them. Through AIC and the Health Promotion Board (HPB), MOH will continue to work closely with the grassroots and community partners, including the Family Service Centre and Senior Activities Centres, to encourage more eligible Singaporeans to join the scheme. MOH will also continue to explore ways to target our outreach to the lower- and middle-income Singaporean households, including measures to facilitate Page: 144 those who live in rental flats to join CHAS and benefit from the scheme.”
“We have also built upon the initial mental health blueprint and introduced new initiatives to further enhance mental health care in the community. Under our new mental health plan in 2012, we started two pilot Assessment and Shared Care Teams (ASCAT) which are specialist-led multidisciplinary teams that manage the patients who have mental health issues in community-based settings, such as the polyclinic. We have also worked with VWOs7 to pilot Community Mental Health Intervention Teams (COMIT), which provide counselling and psychotherapy services to support ASCAT and our GP partners in caring for the mentally ill. The Agency for Integrated Care has also started working with senior activity centres to enable them to identify seniors with symptoms of dementia and depression, and refer them for early treatment. These new services will be expanded if found to be effective. To strengthen the evidence-base for mental health, HPB, in collaboration with IMH, is working to translate the findings of recent mental health related studies to design more targeted public education programmes. Our mental health plan is aligned to the recommendations of the WHO Comprehensive Mental Health Action Plan, which are to provide services in community-based settings, improve mental health promotion and prevention activities, and strengthen research and the evidence base for mental health. Page: 123 Over the next few years, we will continue to implement the key elements in our new community-based mental health plan.”
“We have made good progress over the past few years on the two key objectives of the National Mental Health Blueprint (NMHBP), which are to promote mental health and reduce the impact of mental disorders. On mental health promotion, HPB has been conducting regular public education programmes to promote mental well-being among children, adults and seniors. In 2012, more than 50 initiatives and activities were organised in schools, workplaces and community settings, to reach out to students and members of the public6 . Page: 122 As patients who have medical conditions like stroke, diabetes, and cancer are at higher risk of developing mental health related issues, the public hospitals have set up programmes to integrate a mental health care component into the care plan of these patients. For example, the Department of Obstetrics and Gynaecology in NUH provides screening and support for women who have developed psychiatric conditions due to postnatal depression or gynaecologic cancers. We have also strengthened the provision of mental health services in the community, so as to improve accessibility for people who need assessment. The hospitals have set up multidisciplinary teams with doctors, nurses and allied health professionals to provide clinical services in the community. We have also introduced programmes for family physicians and school counsellors to enable them to better manage mental health conditions. For example, The Response, Early Intervention and Assessment in Community Mental Health (REACH) team led by IMH, KKH and NUH, in collaboration with MOE, is an early detection and intervention programme for schools. REACH is available to all mainstream schools and 20 special schools. In 2012, 849 students were referred to the REACH team for further assessment.”
“We hope to leverage on the higher awareness of HOTA over the years to educate the public about how they can help others live productive lives by allowing their organs to be used, should they become brain dead or by pledging their organs for the purposes of transplant, education or research after they pass away under the Medical (Therapy, Education and Research) Act. Through an integrated campaign, we hope to highlight the life-transforming benefits to organ transplant recipients. We will also leverage on social media for better outreach to the younger generation. We will also continue to work with physicians to encourage living donations.”